Nursing Elites

1. A unit director at a local hospital knows even leadership may face ethical dilemmas. Which of the following should the director take into consideration when dealing with an employee who is incompetent?

• A. The situation should be tolerated for as long as possible because of the amount of time and paperwork required to terminate an incompetent nurse.
• B. Incompetence only impacts the individual nurse.
• C. The director should follow her institution�s formal process for reporting and handling practices that jeopardize patient safety.
• D. Most nurse practice acts direct how to handle incompetent nurses.

Correct answer: C

Rationale: The director should follow her institution�s formal process for reporting and handling practices that jeopardize patient safety.

2. Which of the following presents an important emerging challenge to changes in health care?

• A. Decreased immigration
• B. Nursing staff shortages
• C. Bioterrorism
• D. Increased surgical procedures

Correct answer: C

Rationale: Bioterrorism is considered an important emerging challenge to changes in health care due to its potential to disrupt healthcare systems, cause mass casualties, and create public health emergencies. Choices A, B, and D are not directly related to emerging challenges in health care. While nursing staff shortages are a significant issue, bioterrorism poses a different kind of threat that requires specific preparedness and response strategies.

3. According to Maslow's theory, which level of needs must be met first?

• A. Self-actualization needs
• B. Esteem needs
• C. Safety needs
• D. Physiological needs

Correct answer: D

Rationale: According to Maslow's hierarchy of needs, physiological needs are at the lowest level and must be satisfied first before an individual can progress to fulfilling higher-level needs. Physiological needs include basic requirements for survival such as food, water, shelter, and sleep. Esteem needs, safety needs, and self-actualization needs are higher-level needs that can only be addressed once physiological needs are adequately met. Therefore, the correct answer is D, physiological needs.

4. Which of the following is a common characteristic of a high reliability organization (HRO)?

• A. Flexibility
• B. Reluctance to simplify
• C. Preoccupation with failure
• D. Deference to expertise

Correct answer: C

Rationale: A common characteristic of a high reliability organization (HRO) is a preoccupation with failure. HROs focus on identifying and addressing potential failure points to prevent errors and maintain high levels of safety and reliability. This mindset helps them anticipate and mitigate risks proactively, leading to better outcomes and performance. Choices A, B, and D are incorrect. While flexibility, reluctance to simplify, and deference to expertise may be important in various contexts, they are not the primary defining characteristics of a high reliability organization. The core focus of HROs is on continuously monitoring for potential failures and working to prevent them.

5. A few weeks after an 82-year-old with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding by the nurse is most important to discuss with the healthcare provider?

• A. Hemoglobin A1C level is 7.9%.
• B. Last eye exam was 18 months ago.
• C. Glomerular filtration rate is decreased.
• D. Patient has questions about the prescribed diet.

Correct answer: C

Rationale: The most important finding to discuss with the healthcare provider is the decreased glomerular filtration rate. In patients on metformin therapy, monitoring kidney function is crucial as metformin is primarily excreted through the kidneys. A decreased glomerular filtration rate can lead to metformin accumulation in the body, increasing the risk of lactic acidosis, a serious adverse effect. The hemoglobin A1C level being 7.9% indicates poor diabetes control but can be addressed through medication adjustments and lifestyle modifications. The patient needing an eye exam after 18 months is important but not as urgent as discussing the decreased glomerular filtration rate. Patient questions about the prescribed diet can be addressed during the visit without the need for immediate healthcare provider intervention.

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